Health literacy is defined by the Institute of Medicine in its 2004 report entitled, Health Literacy - A Prescription to End Confusion, as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (2)." Limited health literacy has been associated with a range of adverse adult health outcomes including increased risk of hospitalization, decreased utilization of preventive health services, adverse disease-specific outcomes, and death (3-6). Few studies, however, have examined the relationship between parental health literacy skills and chronic childhood illnesses. One childhood illness in which health literacy is potentially important is Attention Deficit Hyperactivity Disorder (ADHD). ADHD is one of the most common chronic diseases of childhood, affecting 5-10 percent of school-aged children in the US (34-37). Multiple studies have shown the efficacy of medication therapy in the treatment of ADHD (44, 45);however, the data also demonstrate that only half of all children with ADHD utilize evidence- based medication regimens (34). The effective management of ADHD is complex, often requiring daily medications, the utilization of behavioral modification techniques, and close communication between parents, schools, and health care facilities. Given the complexities of ADHD management, we hypothesize that limited parental health literacy is likely to negatively impact the outcomes of children with ADHD. We propose to study the feasibility of a 6-month prospective cohort study to be conducted at Boston Medical Center, an urban safety-net hospital. We believe that a feasibility study, in which we will follow 40 parent/child dyads for 6-months, will allow us to develop the capacity to recruit and maintain an appropriately powered study in the future. This is particularly important in our population for whom the risk of poor follow-up may be increased by socioeconomic risk factors and parental ADHD. The aims of our study will be to: 1) Field test the logistical aspects of the study;2) Obtain empirical estimates of study parameters that will inform the planning of an appropriately powered prospective cohort study;and 3) Obtain estimates of the associations between parental health literacy and the following measures: a) use of pharmacologic therapy for the treatment of child ADHD, b) parental ADHD-specific health knowledge, c) number of both attended and missed medical appointments for ADHD management, and d) change in child ADHD symptoms over time. If limited parental health literacy is found to be associated with poor child ADHD outcomes, we plan to develop specific interventions to increase the use of effective ADHD therapies for children of parents with limited health literacy skills. PUBLIC HEALTH RELEVANCE: ADHD is a common childhood illness associated with considerable morbidity, yet many families fail to utilize evidence-based treatments. It is the potential mutability of health literacy and the capacity of the health care system to accommodate specific needs which makes it such a desirable risk factor to consider. If limited health literacy is found to be associated with poor child ADHD outcomes, we plan to develop interventions to increase the utilization of effective ADHD therapies in children of parents with limited health literacy skills.